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Advance Care Plan
Document
 Download
Advance Care Plan Document (PDF) ~ English Version
Download Advance Care Plan Document (PDF) ~ Spanish Version
View PDF files with Adobe Acrobat Reader.
Distinguishing
Features of the Project GRACE Advance Care Plan Document:
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Promotion of use by
all properly trained physicians in Florida as part of the routine
care of their patients.
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A standard document
that would enable proper uniform approach to patient care in all
hospitals and by various health care professionals.
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Establishment of a
central Internet registry, easily accessed by health care
professionals, an important step towards ensuring that patients'
treatment choices are honored.
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Medical scenario
specific: covering common end-of-life scenarios that most concern
citizens and provide choices for treatment.
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Presented in a concise
one-page document, written in simple, easy to understand language.
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Conforms to Florida
law.
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Prepared for
progressive implementation throughout the state, one community at a
time.
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Tested by focus groups
comprised of the public, physicians and health care workers
establishing ease of use and maximum level of acceptance.
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Established to promote
discussion between patients and physicians regarding end-of-life
care.
What
to do with this Advance Care Plan Document:
-
Always keep your original document.
Put it with your personal files where it is accessible to others.
-
Give a copy to your
physician(s).
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Take a copy to the hospital
each and every time you are admitted.
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Give a copy to your
designated Health Care Surrogate, explain the meaning and purpose of your
Advance Care Plan to your surrogate, and have an in-depth discussion about
your goals of care and wishes at end-of-life.
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Tell your closest
relatives what is in the Advance Care Plan document.
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Give a copy to your
Spiritual Leader.
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If you have a pre-existing
Living Will or Advance Care Plan, destroy the old document and any existing
copies and give copies of your new document to the above individuals.
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Some States require an additional
form to be completed if you do not want cardiopulmonary resuscitation (CPR) attempted.
You should check with your health care provider or State health officials to find out if your
State requires an additional form to prevent unwanted CPR (Do Not Attempt Resuscitation
Form or "DNR" form).
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If you feel this document is useful to you, share
the idea with friends and relatives and refer them to Project GRACE for further information and
their own Advance Care Plan.
"One important ingredient of the medical
profession is a firm commitment to the patient not to abandon them
until the end. It is what makes medicine such a great profession;
Filled with joy and sorrow, exhilaration and sadness, but always
compassionate, caring and altruistic. Its moral authority derives
from the fact that the patients' well-being is paramount from
beginning to end." -Lofty Basta, M.D., A GRACEful Exit
Copyright waived for individual use and downloading. The printed
version form is valid. If you wish an original form, please contact
Project GRACE.
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